An implanted port (port-a-cath or mediport) is a small medical device placed completely beneath the skin to provide reliable access to the bloodstream. This central venous catheter is designed for patients needing long-term or frequent intravenous treatments. It eliminates the need for repeated needle sticks into peripheral veins, which can be difficult to access or sustain damage over time. The placement procedure is common for patients with chronic conditions requiring consistent access to a large central vein.
Defining the Port and Its Purpose
The implanted port consists of two main parts: the port body (a small reservoir) and a thin, flexible catheter. The port body is typically made of plastic or metal and is roughly the size of a quarter, sitting just beneath the skin, usually in the upper chest. It features a raised center made of self-sealing silicone, called the septum, which serves as the access point for specialized needles.
The catheter connects to the port body and is threaded into a large central vein, most often the superior vena cava, which leads directly to the heart. This placement allows medications to be delivered quickly into the bloodstream and helps dilute potentially irritating drugs. Ports are used for long-term treatments, such as administering chemotherapy, prolonged courses of antibiotics, nutrition solutions, or for frequent blood sampling. Utilizing the port protects smaller peripheral veins from the wear and tear of repeated access or harsh substances.
Preparing for the Placement Procedure
Preparation begins with an initial consultation and a thorough review of the patient’s medical history and allergies. The medical team reviews all current medications, especially blood thinners, to determine if they need to be temporarily paused. Baseline blood tests, including coagulation panels, are often required to ensure the patient’s blood can clot properly before the procedure.
Patients are typically instructed to fast after midnight the night before the procedure in preparation for potential sedation. On the day of the procedure, patients should wear loose-fitting clothing and remove all jewelry and piercings to maintain a sterile field. Although the procedure can be done with local anesthesia alone, many patients receive moderate sedation through an arm IV to help them relax and remain comfortable.
The Placement Procedure Step-by-Step
Port placement is a minimally invasive procedure, usually performed by an interventional radiologist or a surgeon, and typically takes less than an hour. The patient is positioned on the table, and the skin on the neck and chest is thoroughly cleaned with an antiseptic solution. A sterile drape is then placed over the body, isolating the area where the port will be inserted to minimize the risk of infection.
Local anesthetic is injected into two areas: the neck (for vein access) and the upper chest (where the port body will sit). The clinician uses real-time imaging, such as ultrasound or fluoroscopy, to precisely identify the target vein, often the internal jugular or subclavian vein. A small needle is guided into the vein, and a guide wire is threaded through the needle into the central circulation.
A small incision is made on the upper chest, usually below the collarbone, and a subcutaneous pocket is created under the skin to hold the port body. The catheter is then tunneled beneath the skin from the chest pocket toward the vein access site. The catheter is connected to the port body, and the entire assembly is secured within the pocket to prevent migration.
Before closing, the position of the catheter tip is confirmed using fluoroscopy to ensure it rests in the distal superior vena cava, just outside the right atrium of the heart. Once placement is verified, the incisions are closed using sutures (which may be absorbable) or surgical glue. A sterile dressing is applied to the incision sites, and the port can often be used immediately following placement.
Post-Procedure Care and Potential Complications
Following placement, patients spend a brief period in recovery while the effects of sedation wear off and are typically discharged the same day. Mild discomfort, bruising, or soreness at the incision sites is common and managed with over-the-counter pain medication. Patients should keep the incision sites clean and dry for the first couple of days and avoid strenuous activity or heavy lifting for about a week.
Long-term care involves maintaining the device’s patency through regular flushing with a sterile saline and heparin solution, performed by a healthcare professional. If the port is not actively used for treatment, this maintenance flushing is necessary every four to six weeks to prevent blood clots from forming inside the catheter. Once the incision is healed, the port requires no special daily care and allows the patient to shower, bathe, and swim.
While the procedure is generally safe, potential complications can occur. Early issues include bleeding, hematoma formation, or pneumothorax if the lung is nicked during vein access. Delayed complications include infection at the port site or within the bloodstream, which is a common reason for removal. Other long-term risks are catheter-related thrombosis (blood clots forming around the catheter) or catheter migration (the tip moving out of position). Patients should seek immediate medical attention if they experience signs of infection, such as fever, persistent pain, swelling, or redness at the port site.